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Post by AKIEYA CUMBERBATCH on Jun 28, 2017 7:33:13 GMT -4
Therapy for Everybody - I do believe this setup of PCP and psychiatrist in a combined practice would be beneficial to many. We know the stigma associated with mental illness is still very prevalent therefore persons would be able to feel more comfortable going to their PcPs. Then, can be provided the psychiatric evaluation they need without fearing persons making judgements of their health. We must be mindful that PCPs are broad based doctors majority do not specialize in one particular area thus they would not be equipped with all that's necessary for treatment of a psychiatric illness. Also, time must be factored in with psychiatric patients. Just handing out a written prescription won't be sufficient and truthfully PCPs just don't have that time to adequately give.
Ketamine - This drug seems to hold all the power to long term depression and as soon as scientist can wrap their heads around the particular region of the NMDA receptor and conduct larger studies that will pin-point the short term & long term side effects of the drug I do believe we would have found the answer to treating long standing depression. Depression is one of the most diagnosed problems and it is taking over the entire being of a person if not treated (even the younger kids). Additionally, they are numerous persons who have tried every drug in the book for depression and can still can give reports of days where they experience "down-hill" feelings and thoughts of suicide. Ketamine is a very dangerous drug but with proper knowledge, correct administration and further research on the role Ketamine can play in mental health treatment I believe this drug or derivative of this drug will bring many benefits.
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Post by Amy Emtage on Jun 28, 2017 8:41:04 GMT -4
Therapy for Everyone
The concept of integrated health is excellent. We have striven for many years to develop specialties so that more precise care could be provided for individual patient needs. However, while this specialization has allowed for technical advancement in focused fields it has hindered holistic care. Many patients are seeking an approach to health that addresses them as a whole person and not a multiplicity of sub specialties each addressed at a different office by a different practitioner. It is impractical to make multiple appointments at multiple locations and to reexplain your case to each provider. Retail understands this. One-stop-shops like Walmart include everything on your shopping list from groceries to soap to tennis shoes and you only have to find a parking space once to get through the ordeal. If you want a very specific set of high heels you can pay the price and go to a store which specializes in fancy footwear. People have diverse needs but are still one person. A holistic approach which allows multiple and often overlapping needs to be treated together is both simple and effective.
Ketamine as an Antidepressant
Understanding the mind is a challenging science because much is still unknown regarding the cause and effect of both disease processes and treatments. Using NMDA receptor blockers as antidepressants is an encouraging direction for therapy because it is based on an actual physiological cause and effect rather than a nebulous concept that this "chemical should work but because it has before we don't know why" that frequently underlies other pharmacotherapy. Beginning "somewhere" is as good a place to begin as any but not being able to explain the rational behind our medication choices physiologically hinders providers from disease process specific approach. We must begin by treating symptoms but the goal of research is to eventually define the pathology and correct the underlying cause. Ketamine has observable beneficial effects but understanding why may help us to understand what is broken and how to address it specifically. This is at least one step in the right direction.
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Post by Melvin George on Jun 28, 2017 12:03:13 GMT -4
Therapy for Everybody Quick sessions of psychotherapy in primary care offices are great for a number of reasons. Most people that are able to see a psychologist regularly are usually well off financially. The many Americans that need to see one are just hanging on and might not ever make an appointment to see a therapist. These blitz psychotherapy sessions are a good way to get therapy to someone that otherwise might not ever get the help they need. Another added benefit is that the patient can see a therapist without worrying about running into friends or family as they walk out of a mental health clinic.
Ketamine as an Antidepressant Using ketamine to treat depression is a hot topic. There are those that say ketamine is too problematic and that its side effect profile is too dangerous to advocate its use in the mainstream treatment of depression. The long term effects of taking the drug are also not well studied. This article discusses new research into how ketamine works in the brain to cause anti-depressant effects. ketamine does in fact block the NMDA receptor but in a particular region. This allows more research into developing drugs that block the NMDA in a similar way to ketamine without its known side effects.
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Post by trupalpatel on Jun 28, 2017 12:50:52 GMT -4
Ketamine
Ketamine has been used worldwide since its introduction in the 1960s as a psychedelic, anesthetic, analgesic, and anti-depressant. Recently, as more and more research is done via animal and human clinical trials, the mechanism of action has been clarified. The NMDA receptor antagonism mechanism of the drug affects glutamate, which the typical anti-depressants that target dopamine, NE, 5-HT, do not. A study conducted in mice found that ketamine's antidepressant activity is not caused by ketamine inhibiting NMDAR, but rather by sustained activation of a different glutamate receptor, the AMPA receptor, by a metabolite, (2R,6R)-hydroxynorketamine; as of 2017 by a study published in ACS chemical neuroscience. They discovered that Arketamine is an indirect AMPA receptor activator.
The current dosing and forms of ketamine can be IV, PO, or nasal. Ketamine has been shown to have bronchodilatory effects in asthmatics. In a new study by the Am.Society of Clin. Pharm. 2017, the various dosages in IV forms over 45 minutes in patients with depression were compared along with a single dose medazolam placebo. They found that the infusion rate 0.5mg/kg and 1.0mg/kg groups had the highest improvement following assessments at 0,1,3,5,7,14, and 30 days intervals. A survey by Yale by Samual Wilkinson, MD found 57/76 responding physicians who used ketamine across the US. Majority were psychiatrists,but anesthesiologists, ER, family, and PM&R were others noted to be treating patients with some form of ketamine. When all other options fail, its important to discuss ECT or ketamine as therapy if the patient is actively suicidal and severely depressed. The side effects of dissociation and liver metabolism warrant close monitoring and those guidelines could be created with a registry or database to help the FDA approve low doses for depression and possibly bipolar depression.
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Post by trupalpatel on Jun 28, 2017 12:59:52 GMT -4
Psychotherapy
This is a great article showing the integration of mental and physical health. You can't have one without the other. Many conditions that affect the brain have an effect on the body, and conditions that affect the body, affect a patient's mood. This integrated pyschotherapy in clinics in the appalachian region is a necessity and could be a great model for the nation and other rural areas. I see a therapy session becoming part of the wellness check requirements. The two psychotherapists in the article have valuable experiences in non-clinic settings that help them with the quick visits. As mentioned before in the PTSD article, the stigma of looking weak affects patient compliance and this integration can definitely help keep confidentiality. When primary care doctors have an on-site therapist, they are able to refer and quickly solve any mental health issues that may be co-morbid with a physical condition. They will also get a direct recommendation for prescribing psychotropic medications without having the patient wait another month to see a psychiatrist. The added benefit pays for itself as mentioned, more patients can be seen by the freed up doctor to allow payment for the therapist.
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Post by Ifeoma Okponyia on Jun 28, 2017 16:44:09 GMT -4
Therapy for everyone:
I genuinely believe that therapy is for everyone, whether getting professional help or simply talking with a friend, a loved one or family member. At the end of the day a common goal is achieved, and that goal is simply releasing a few burdens from the heart. Just talking can be therapeutic, so being able to identify the problem and talking about them relieves symptoms. We live in a society today where going to a therapist makes an individual feel as though they are weak, incapable of solving problems on their own or that they are “crazy”. But it goes beyond that. People often are afraid of how they’d feel if others saw them in this light, namely worthless, flawed or unlovable. So instead of going, they cancel appoints and deny themselves the right to seek help.
The reality is that most people in therapy are ordinary, everyday people dealing with ordinary, every problem. Adjusting to new relationships, major life circumstances, experiencing grief and processing all kinds of emotions and working on one-self. The article stated that, “Religion is a source of comfort and strength to many here. But a deep devotion to Christianity is viewed, by some, as a replacement for professional psychological help. “There’s a lot of ... thinking that, if you go to church, if you pray, if you’re faithful, you can get over a mental illness,” Waters said.” This is sadly true. For some, praying can bring a lot of clarity and calmness but for others, an opposite manifestation. I believe that those with opposite manifestation of calmness and clarity should go beyond the church and seek professional help.
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Post by Ifeoma Okponyia on Jun 28, 2017 17:14:19 GMT -4
There's More Proof That Ketamine Works for Depression
The headline almost sounds unreal, seeing that ketamine has a reputation as an illicit party drug due to its hallucinogenic effects. Ketamine is a drug that acts quickly often within hours or less and if given to patients at therapeutic doses, will probably produce the least side effects. The worrisome part of patients receiving ketamine is that the antidepressant effects wear off after a few day or weeks, meaning these patients will need repeated infusions to keep the depression down, this can potentially lead to unwanted addiction and long-term side effects. I can just imagine all the non-depressed individuals who would present to the doctor’s office claiming to be depressed just so that they can also receive ketamine for it non-medicinal purposes, something similar, to medical marijuana use.
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Post by christophercordeiro on Jun 28, 2017 22:28:34 GMT -4
Therapy for Everybody:
I do believe the integration of a mental health specialist at a primary care clinic would improve the quality of life in many people. Since there has still been stigma around mental health, a lot of people shake off their condition as being "in their head". More people would be inclined to try out psychotherapy because of its easy accessibility and would be surprised of how helpful it really is. I do think a lot more programs/clinics are moving towards a holistic approach with mind and body, which will be interesting to see in the coming years.
Ketamine for Depression:
I am always up for new ideas and research. I think researchers have found something really promising with ketamine. Since most of the antidepressants have been around for years its exciting to see something new. It seems to be working really well for patients with long standing depression that has not been treatable by the standard care of therapy. However, I am concerned of the possible long term side effects and possibility of abuse in regards to tolerance. I am excited to see what further research brings when the ketamine binding location is depicted and what other possibilities there are.
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Post by Nathan Spencer on Jun 29, 2017 0:17:54 GMT -4
Therapy for Everybody: I think it's outstanding that they are pushing residents and physicians to begin implementing more psychotherapy into their practice approach. I really agree with the article when it said that everybody can probably benefit from it. I think this is something that is very much needed, especially in the primary care setting in geographic regions where access to more direct psychiatric help might not be realistic. Another thing that the article mentioned was the anonymity that a patient could receive, as others in the waiting room wouldn't know if they were there to receive psychiatric support also. I think this another great component too... it really is something that makes a difference and contributes to the low follow through rate on referrals to psychiatric care now. It seems as though integrating more psychiatric support into all other areas of practice will yield essentially only positive consequences.
Ketamine for Depression: I'm a huge believer that the same treatments don't work the same way for everybody, and as such, I think it's exciting to hear that we have found a novel way to treat resistant depression. That being said, I certainly understand that Ketamine certainly isn't the golden ticket just yet... between the growing recreational use of Ketamine on the streets & the plethora of unwanted side effects, we're far from calling it the new miracle drug. Nonetheless, as we continue learning the intricate pathways in the body that Ketamine utilizes and affects (NMDA and otherwise), perhaps this will unlock a key & help us to develop something new that will really break down barriers in resistant depression within the next decade.
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Post by Sylvia Akenji on Jun 29, 2017 0:37:29 GMT -4
I think it's a great idea that new ways are being discovered for the treatment of depression. That being said the challenge will finding the right ways to dispense the drug. Although Ketamine is already clinically used as an anesthetic it has its popularity in being a great party drug by the general public. There are also many side effects and drug drug interactions that providers need to be aware of even the doses used to treat depression are supposedly much lower than those used for anesthesia. Research needs to be geared to finding the best methods of using the drug. Moreover safe dispensing methods should be used such as in office only treatment or dispensing clinics for example. This may reduce the chances of increasing its access to the community.
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Post by Vivake Umadat on Jun 29, 2017 8:55:55 GMT -4
Ketamine for Depression:
-I think this article poses a very exciting potential treatment in the realm of otherwise "treatment resistant" Depression. In the ever evolving world of Medicine it is important to work on new strategies that are safer and more effective at managing medical conditions. It seems to be that Ketamine or a Ketamine-like compound that acts at the same site on the NMDA receptor shows promise at controlling the symptoms of hard to manage Depression. This opens up a new world of research that can be done on the NMDA receptor itself and on Ketamine to potentially change treatment options in the upcoming years. It is known that Ketamine is used currently to elicit other unwanted medical, but desirable recreational effects in the general public. This can be said with many other prescription medications. If they fall into the wrong hands many will use them for their own personal pleasure rather than what they are intended to be used for. In Canada there is currently a Fentanyl epidemic. The Opioid medication, which controls pain exceptionally, medically, is being used by the public in an unsafe manner ultimately leading to death upon overdose. This is something that is hard to get away from as there will always be individuals who experiment with pharmaceuticals for their own purposes. As long as Ketamine is properly researched for it's beneficial medical effects and safeguards are put in place so that the prescribed Medical consumer takes the Ketamine or Ketamine-like compound in a safe and effective manner that alleviates their diagnosed Depression then I think the possibilities with this research are very promising, potentially giving Medical Providers more options to better treat their patients.
Therapy for Everyone:
-This article is very interesting in that it essentially explores the lack of adequate mental health assistance when going to see primary care/ED doctors. I think it's a great idea that Psychologists are now being implemented into the primary care setting to better manage and diagnose mental health issues. As stated in the article, Mood Disorders eat up a good portion of the US health care costs, so a better, earlier and more effective way to triage and treat these patients would alleviate stress on the health care system. As with any medical issue, a patient would feel most comfortable talking to someone who is an expert with their issue as that person's advice directly affects their body and its inner workings. Mental health evolving around one's mind, thoughts and actions may bear even more weight on this notion. Since medicine is a holistic science ensuring that the mind, body and soul are all functioning optimally, naturally it makes sense that medical care is properly able to assess all of these areas upon patient examination. This also allows Psychologists and Physicians to work hand in hand allowing each to learn from one another and keep a closer eye on their patient from both a Medical and Psychological standpoint upon the starting of treatment. I am excited to see how many areas adopt this practice.
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Post by Mario Mejia on Jun 29, 2017 9:46:25 GMT -4
Therapy for Everybody
I had never heard of this type of integrated therapy, but it sounds like it could be extremely beneficial in all practices. Access is many times a problem for patients. That coupled with the stigma surrounding mental health, it is no wonder many patients who need therapy go without it. Where I am from, mental health is not something that we actively discuss. As is the case with many cultures. I have experienced first hand where someone battling depression would benefit from therapy, however, it is considered an issue that should be dealt with on your own. The idea of having therapists in the primary care physicians office allows some patients to receive necessary treatment without the added pressures of having to go to a therapists office. I do not necessarily agree that this is the best route, but when there are so many things stopping people from receiving treatment, this seems to be a good gateway to therapy.
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Post by Mario Mejia on Jun 29, 2017 10:20:05 GMT -4
Ketamine
It is great that they are finding new ways to treat depression, especially with patients who are resistant to conventional treatments. There are so many drugs that have off-label uses that it is hard to understand why there isn't more research exploring the possibilities of altering these drugs so that they may repurposed. Until a new formulation of Ketamine can be accomplished to rule out certain side-effects, treatment will have to be followed very closely as there is no information on its long term effects. Identifying how it blocks the NMDA receptor was a crucial step in the right direction to using this drug solely for depression treatment. It also may open doors to new treatments that may use this same mechanism of action.
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Post by Monica Gifford on Jun 29, 2017 10:46:47 GMT -4
Therapy For Everybody: I love the concept of incorporating a psychiatrist into a primary care clinic. There are so many people who do not know that their stressors in life are linked to a psychological disorder. There are also plenty of patients who need the help of a mental health professional, but do not want to seek that help for personal reasons. It would make it easier on both the patients and the physicians to have those practices integrated.
Ketamine as an Antidepressant: It must be a scary topic for discussion to think that a drug like ketamine could be used to treat depression. However, I think it should be viewed as something incredibly positive. The patients in need of a drug like this are desperate to find something to relieve them from their everyday struggles. If ketamine could help even one patient suffering from a medication resistant depression, then I believe the researchers should continue to pursue it to the fullest.
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Post by Anis Said on Jun 29, 2017 10:55:40 GMT -4
Therapy for Everybody: Integrated behavioral health practice is a genius idea that makes psychotherapy and psychiatrist more accessible. Primary care clinics usually do a great job for caring for the body, but do very little to take care of the mind. Mental health should be taken seriously and using integrated behavioral health practice is a way to reach out to more mental health patients who are in need of psychotherapy. Psychotherapy can lower the patients’ reliance on anti depressants and it can offer alternative ways to deal with depression and other mental health problems like addiction and suicidal ideation. Using this model helps patients overcome the stigma associated with mental health especially in rural areas and it gives patients more privacy. Having a mental health professional at the primary care clinic can allow for a more proper and accurate diagnosis and better management of mental health disorders. Integrating a psychiatrist into primary care offices can generate more income for the clinic and it can reduce the overall cost of health care. There's More Proof That Ketamine Works for Depression This article gives hope to many patients struggling with depression especially those who do not respond well to the available antidepressants. In order to develop a new antidepressant, it is crucial to understand the mechanism of action of drugs like ketamine which has a rapid anti-depressant effect/side effect. Understanding the mechanism of action can help scientists develop a drug that works similarly while avoiding the cardiovascular side effects of ketamine. Ms. Monteggia’s work can pave the way for the future development of NMDA receptor blockers as antidepressants.
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